Body Fluid Exposures

Question 1

Approach to needle stick incident:

Answer 1

• First Aid: wipe soiling, wash soap/water
• Relieve from clinical duties, support
• Incident report
• Risk details:
  —> Mode of exposure (hollow bore, body fluid type)
  —> Patient: Dx, viral load, med compliance
  —> Victim: Hep B vacc status, ADT status
• Obtain serology from source + victim (if agreed)
• +- PEP (discuss with ID)
• +- ADT
• Follow up counselling/ serology at:
  –> 3 weeks (counsel + results)
  –> 3 months (repeat serology)
  –> 6 months (repeat serology)
• Counsel
  –> Safe sex/ toothbrushes/ needles/ blood donation, avoid pregnancy

Question 2

What serology should be obtained from victim, and from source, in a body fluid exposure:

Answer 2

SOURCE
- HIV antib
- Hep C antib
- Hep B surface antigen (?infectious)

If already known +, quantify infectiousness:
–> HIV: viral load
–> Hep C: RNA
–> Hep B: e-antigen + quantitative PCR

________________________

VICTIM
Determine what they already have + what they are immune to. TOO EARLY to detect new infection- that’s what 3mo serology is for
- HIV antib
- Hep C antib
- Hep B surface antibody (? immune)

Question 3

What infers a ‘high risk’ body fluid exposure:

Answer 3

Patient known +, higher viral load
Visibly soiled
Hollow-bore
Deep
Not immunised
Large volume, prolonged period of contact
Blood, vs other body fluids (slightly)

Question 4

What are the transmission rates for body fluid exposure for:
- HIV
- Hep B
- Hep C

Answer 4

If the source is known to be +:

3,3,3

HIV 0.3%
Hep B 30% (if not vacc’d)
Hep C 3%

Question 5

Post-exposure prophylaxis (PEP) regimen HIV:

Answer 5

Best within 2 hours but up to 72 is effective.

Regimen- Truvada daily & Raltegravir BD (3 drug regimen)

Duration- 28 days

Side effects:- Non-specific: headache, nausea, vomiting, rash, GI.
Truvada can cause renal impairment, but very unlikely with short course.

*Truvada = emtric + tenofovir

Question 6

Is PEP required if the source has HIV with an undetectable viral load?

Answer 6

No. HIV cannot be transmitted.

Question 7

Post-exposure prophylaxis (PEP) regimen HEP B:

Answer 7

If non-immune (low Hep B sAb titres):

• Hep B immunoglobulin x1 dose
• Catch-up schedule of 3x Hep B vaccinations
  (+ check for seroconversion post)

Like HIV: within 72 hours. Earlier better.

Question 8

Post-exposure prophylaxis (PEP) regimen HEP C:

Answer 8

No PEP regime.
Very effective curative treatment.

Question 9

PEP in pregnancy:

Answer 9

Standard HIV and Hep B regimes are fine.